Modified Stoppa Approach Alone or in Combination with a Lateral Window for Acetabular Fractures Involving Both Columns.

Purpose: Complex acetabular fractures involving both columns often require two approaches, one anterior and other posterior, for adequate reduction and fixation. Treatment of such fractures using modified Stoppa approach (MSA) either alone or in combination with lateral window of the ilio-inguinal approach has been reported. Whether this line of management is appropriate or not is a matter of further investigation. This study presents the clinical and radiological outcomes of acetabular both-column fractures using this approach.

Materials and methods: Forty-one patients treated with MSA for anterior column with posterior hemi transverse (AC with PHT), associated both columns, T-type, and transverse fractures were postoperatively assessed at a minimum of one year. Their immediate postoperative reduction quality, as well as the clinical, radiological, and functional outcomes at the most recent follow-up visit were reviewed.

Results: Most patients were young males injured in motor vehicle accidents who underwent surgery after a mean delay of 4.8 days. The mean surgical time was 122.44 minutes, and mean blood loss was 413.41 mL. AC with PHT fracture was the most common. In 78.0% of cases, anatomical reduction was achieved. At one year, excellent radiologic, clinical, and functional outcomes were observed in 78.0%, 51.2%, and 73.2% patients, respectively. There were eight cases with major complications.

Conclusion: Using the MSA with satisfactory short-term results, it was possible to address acetabular fractures involving both the anterior and posterior elements in a select group of patients. A pelvi-acetabular surgeon should have expertise in using multiple surgical approaches including the MSA.